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Home My WebLink AboutBLDG-22-002150 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK ., 60 CITY YARMOUTHkz,, MA DATE October 14,2021 PERMIT# BLDG-22-002150 t( ' JOBSITE ADDRESS 49 MONOMOY RD OWNER'S NAME Cynthia Morton G OWNER ADDRESS YARMOUTH PORT MA 02675 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL ID PRINT CLEARLY NEW: 0 RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES ❑ NO❑ FIXTURES FLOORS BSM 1 2 - 3 4 5 6 7 8 9 10 11 12 13 14 BOILER - BOOSTER CONVERSION BURNER - , COOK STOVE +-DIRECT VENT HEATER - DRYER 1 FIREPLACE FRYOLATOR FURNACE _ - GENERATOR GRILLE INFRARED HEATER _ _ _ LABORATORY COCKS _ MAKEUP AIR UNIT OVEN POOL HEATER ROOM/SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER - - WATER HEATER _ - OTHER OTHER DESCRIPTION: INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES El NO❑ IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY ❑ OTHER OF INDEMNITY❑ BOND ❑ OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME John Kane LICENSE# 22755 SIGNATURE MP 0 MGF ❑ JP❑ JGF❑ LPG! 0 CORPORATION 0# PARTNERSHIP ❑# LLC 0# COMPANY NAME: JOHN KANE ADDRESS. 39 MONOMOY RD, CITY S YARMOUTH STATE MA ZIP 026641984 TEL FAX CELL EMAIL sik1725 at7,gmail.com S3LON M3IA3H NVId #1M I3d $:33A El El 1II 3d 3H1 SV SSAH3S NOI LV3I1ddV SIHl a seA S310N N01133dSNl 1VNld AINO 3Sfl 2l0.133dSNl 210d 3OVd SIHl. S310N N01103dSNI SV9 HOflO MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS Fr I t 1NU vvutcr. ¢' — CITY: S ` Y 4 v U(J i l^ MA DATE:E: /0 -/LI- al PERMIT t z wI` JOBSITE ADDRESS: 4- cl In u YI rd !M �v'/ 2 Clcl OWNER'S NAME: CY i r q i 1 a✓i o✓l LLI opsi . 1 cc OWNER ADDRESS: So r"1- TEL: 50 -3 8 0 0581 FAX: - .7 Tr. !' OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDEN I iAL V IL Ct° ' Y NEW:0 RENOVATION:0 REPLACE TENT:® PLANS SUBMI t!Ea YES❑ NO I W a A9I ' CESZ FLOOR-, I 6smt 1 1 2 3 1 4 5 6 7 I 8 9 10 11 12 13 I 14 Ct---soi!1 I 1 1 [ 1 I I I CONVERSION BURNER I I COOK STOVE I DIRECT VENT HEATER DRYER I , i I FIREPLACE I I 1 I I FRYOLATOR I i l I FURNACENY I I I u I GENERATOR I I TiILLE L (3 I. INFRARED HEATER I I t I. LABORATORY COCK I I I MAKEUP AIR UNIT 1 OVEN I J POOL HEATER I j 1 ROOM/SPACE HEATER I I I I I ROOF TOP UNIT I I J TEST _ I I � r 1 UN'VEN T ED ROOM HEATER I I 1 WATER HEPLI i ( I HH _ I 1 1 1 f I I I I INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142 YES ® NO 0 If you have checked YES,please indicate the type of coverage by checking the appropriate box below. . LIABILITY INSURANCE POLICY I OTHER TYPE INDEMNITY ❑ BOND 0 OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit apptiica'iion waives this requirement. CHECK ONE ONLY: OWNER ❑ AGENT 0 SIGNATURE OF OWNER OR AGENT hereby certify that all of the details and'information I have submitted(or entered)regarding this application are true and accurate to the best of my Knowledge and that all plumbing work and inslitations performed under The permti issued for this applicaion will be in compliance with all Pertinent provision of The Massachusetts State Plumbing Code and Chapter 142 of the General Laws. (ti. PLUMBERJGASFI I I t_K NAME: �4 in n K v `- LICENSE# �3 a7 TS- SI NATURE COMPANY NAME .TG cit. 16i At l�o 0 f r o c f in 9' ADDRESS: 3 I rn 0 n a Yh u i I IZ a CITY: S-1 a r vv. STATE P a ZIP: 0 2 G 6 Y FAX: TEL: Gam.: 5-0 Fl-68,5 -S6 S6 EMAIL 5 3 1 1 a 5 6 9 me ,'I • Ci v►-, MASTER❑ JOURNEYMAN 0 LP INSTALLER❑ CORPORATION 0- PARTNERSHIP 0= t!C❑'—